Abstract
Aim
To evaluate changes in the oral health status of children under the age of 14 years with acute lymphoblastic leukaemia (ALL) attending a cancer centre before and after chemotherapy treatment.
Materials and methods
A total of 32 children with ALL without distinction of gender were selected for study. The oral cavity of the patients was evaluated before the induction stage and 17 days later. Clinical evaluation of the submandibular, submental, and cervical lymph nodes was performed. Saliva samples were collected during the early morning hours. Bacterial plaque was assessed by using the Silness and Löe plaque index (SLPI) and gingiva status was evaluated with the gingival Löe and Silness index (GLSI). The WHO toxicity oral scale was used to record the degree of oral mucositis. The resulting data were analysed with McNemar’s test, t test (for related samples), and Wilcoxon test.
Results
There were statistically significant differences for palpable lymph nodes, paleness of oral mucosa, and ecchymoseis, respectively, P ≤ 0.000, P = 0.03, and P = 0.01, with these manifestations decreasing significantly after treatment. Incipient gingivitis had frequencies of 71.9% and 75% before and after treatment, respectively. The mean SLPI score declined significantly from 1.16 ± 0.52 (before treatment) to 0.56 ± 0.36 (after treatment) (P < 0.000); salivary flow increased significantly from 0.54 ± 0.34 to 1.22 ± 1.07 after chemotherapy treatment (P < 0.00). Oral mucositis was present in 24 children (75%) with a 1–2 severity level.
Conclusions
After chemotherapy treatment, there were changes in the oral conditions of children with ALL. Some manifestations decreased after treatment, whereas in others increased.
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References
Al-Ansari S, Zecha JA, Barasch A, et al. Oral mucositis induced by anticancer therapies. Curr Oral Health Rep. 2015;2(4):202–11.
Azher U, Shiggaon N. Oral health status of children with acute lymphoblastic leukemia undergoing chemotherapy. Indian J Dent Res. 2013;24(4):523.
Biswas S, Chakrabarti S, Chakraborty J, et al. Childhood acute leukemia in West Bengal, India with an emphasis on uncommon clinical features. Asian Pac J Cancer Prev. 2009;10(5):903–6.
Board, P. P. T. E. Childhood acute lymphoblastic leukemia treatment (PDQ®). In: PDQ cancer information summaries [Inter-net]. National Cancer Institute (US). https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq. Accessed May 28 2018 (PMID: 26389385).
Declerck D, Vinckier F. Oral complications of leukemia. Quintessence Int. 1988;19(8):575–83.
Dholam KP, Gurav S, Dugad J, Banavli S. Correlation of oral health of children with acute leukemia during the induction phase. Indian J Med Paediatr Oncol. 2014;35(1):36. https://doi.org/10.4103/0971-5851.133717.
Francisconi CF, Caldas RJ, Oliveira Martins LJ, et al. Leukemic oral manifestations and their management. Asian Pac J Cancer Prev. 2016;17(3):911–5.
Gandhi K, Datta G, Ahuja S, et al. Prevalence of oral complications occurring in a population of pediatric cancer patients receiving chemotherapy. Int J Clin Pediatr Dent. 2017;10(2):166. https://doi.org/10.5005/iD-iournals-10005-1428.
Harris N, García- Godoy F. Primary preventive dentistry. 6th ed. Upper Saddle River: Pearson Education; 2004.
Hashemi A, Bahrololoumi Z, Khaksar Y, et al. Mouth-rinses for the prevention of chemotherapy induced oral mucositis in children: a systematic review. Iran J Ped Hematol Oncol. 2015;5(2):106–12.
Hou G-L, Huang J-S, Tsai C-C. Analysis of oral manifestations of leukemia: a retrospective study. Oral Dis. 1997;31(1):31–8.
Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2014, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017.
Javed F, Utreja A, Correa FOB. Oral health status in children with acute lymphoblastic leukemia. Crit Rev Oncol Hematol. 2012; 83(3):303–9. https://www.ncbi.nlm.nih.gov/pubmed/?term=Oral+health+status+in+children+with+acute+lymphoblastic+leukemia.+Critical+reviews+in+oncology%2Fhematology%2C. https://doi.org/10.1016/j.critrevonc.2011.11.003.
Kung AYH, Zhang S, Zheng LW, et al. Oral health status of chinese paediatric and adolescent oncology patients with chemotherapy in Hong Kong: a pilot study. Open Dent J. 2015;9:21–30. https://doi.org/10.2174/1874210601509010021.
Löe H. The Gingival Index, the Plaque Index, and the retención Index. J Periodontol. 1967;38:610–6.
Mathur VP, Dhillon JK, Kalra G. Oral health in children with leukemia. Indian J Palliat Care. 2012;18(11):21. https://doi.org/10.4103/0973-1075.97343.
Mazaheri R, Jabbarifar E, Ghasemi E, et al. Oral health status, salivary pH status, and Streptococcus mutans counts in dental plaques and saliva of children with acute lymphoblastic leukemia. Dent Res J (Isfahan). 2017;14(3):188–9.
Morais EF, Lira JA, Macedo RA, et al. Oral manifestations resulting from chemotherapy in children with acute lymphoblastic leukemia. Braz J Otorhinolaryngol. 2014;80:78–85.
Orbak R, Orbak Z. Oral condition of patients with leukemia and lymphoma. J Nihon Univ Sch Dent. 1997;39(2):67–70. https://doi.org/10.2334/josnusd1959.39.67.
Pels E, Mielnik-Blaszczak M. Oral hygiene in children suffering from acute lymphoblastic leukemia living in rural and urban regions. Ann Agric Environ Med. 2012;19(3):529–33.
Pinto LP, De Souza LB, Gordón-Núñez MA, et al. Prevention of oral lesions in children with acute lymphoblastic leukemia. Int J Pediatr Otorhinolaryngol. 2006;70(11):1847–51.
Ponce-Torres E, Ruiz-Rodriguez MS, Alejo-Gonzalez F, et al. Oral manifestations in pediatric patients receiving chemotherapy for acute lymphoblastic leukemia. J Clin Pediatr Dent. 2010;34:275–9.
Pui CH, Relling MV, Sandlund JT, et al. Rationale and design of Total Therapy Study XV for newly diagnosed childhood acute lymphoblastic leukemia. Ann Hematol. 2004;83:S124–6.
Sakeenabi B, Hiremath SS. Dental caries experience and salivary Streptococcus mutans, lactobacilli scores, salivary flow rate, and salivary buffering capacity among 6-year-old Indian school children. J Int Soc Prev Community Dent. 2011;1(2):45–51. https://doi.org/10.4103/2231-0762.97697.
Silness J, Löe H. Periodontal disease in pregnancy. II Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1953;2:153–62.
Sixou JL, De Medeiros-Batista O, Gandemer V, et al. The effect of chemotherapy on the supragingival plaque of pediatric cancer patients. Oral Oncol. 1998;34(6):476–83.
Vanhoecke B, De Ryck T, Stringer A, et al. Microbiota and their role in the pathogenesis of oral mucositis. Oral Dis. 2015;2(1):17–30.
Velten DB, Zandonade E, de Barros Miotto MHM. Prevalence of oral manifestations in children and adolescents with cancer submitted to chemotherapy. BMC Oral Health. 2017;17(1):49. https://doi.org/10.1186/s12903-016-0331-8.
Vourexakis Z. Oral lesions presenting as an early sign of acute leukaemia. BMJ Case Rep. 2015. https://doi.org/10.1136/bcr-2014-205100.
Wang Y, Xue J, Zhou X, et al. Oral microbiota distinguishes acute lymphoblastic leukemia pediatric hosts from healthy populations. PLoS One. 2014;9(7):e102116. https://doi.org/10.1371/journal.pone.0110449.
World Health Organization. Handbook for reporting results of cancer treatment. Geneva: World Health Organization; 1979. p. 15–22.
Acknowledgements
The authors are grateful to the Research Direction of University of Cuenca (DIUC), for financing this research development; to SOLCA-Cuenca-Ecuador and its staff, especially to Dr. Raul Alvarado Corral Director of the Institute, for the financial and logistical support with the installation of a dental unit to perform this research.
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Parra, J.J., Alvarado, M.C., Monsalve, P. et al. Oral health in children with acute lymphoblastic leukaemia: before and after chemotherapy treatment. Eur Arch Paediatr Dent 21, 129–136 (2020). https://doi.org/10.1007/s40368-019-00454-4
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DOI: https://doi.org/10.1007/s40368-019-00454-4